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Body mass index as an indicator of the likelihood of ultrasound visualization of the appendix in pregnant women with suspicion of appendicitis

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Abstract

Purpose

To determine if clinical characteristics of pregnant women are associated with the likelihood of ultrasound (US) visualization of the appendix in cases where there is a clinical suspicion of appendicitis.

Materials and methods

A retrospective study of 471 pregnant patients with suspicion of appendicitis from 2009 to 2018 were studied. Patients underwent sonography of the appendix as their initial imaging study. The association of body mass index (BMI) and gestational age with sonographic visualization of the appendix was analyzed using logistic regression. Cut-off values were determined for BMI to predict visualization of the appendix.

Results

The rate of visualization of the appendix on US was 16% (95% CI 12% to 19%). When stratified by trimester of pregnancy, rebound pain on compression US examination in the 1st trimester and BMI in the 2nd and 3rd trimesters were identified as predictors of US visualization. Applying BMI cut-off values rounded to the nearest whole number, 36, 30, and 26 in the 1st, 2nd, and 3rd trimesters, non-visualization rates would be reduced by 16% (95% CI 10% to 25%), 35% (95% CI 29% to 42%), and 67% (95% CI 58% to 74%). Using BMI index cut-off values would reduce the number of primary US examinations by 35% (95% CI 30% to 39%) and increase the rate of visualization by 6% (95% CI 0.02% to 12%, P = 0.04).

Conclusion

Using BMI cut-off values for determining the efficaciousness of US visualization of the appendix in pregnant women with suspicion of appendicitis could significantly reduce the non-visualization rate.

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Authors and Affiliations

  1. Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA

    Camila Lopes Vendrami, Joon Soo Shin, Lori A. Goodhartz, Jeanne M. Horowitz, Donald Kim & Frank H. Miller

  2. Department of Radiology, Zhangjiagang Hospital, Soochow University, Suzhou, 215600, China

    Xinchun Xu

  3. Department of Anesthesiology, Rush University, Chicago, IL, 60612, USA

    Robert J. McCarthy

  4. Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA

    Frank H. Miller

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  1. Camila Lopes Vendrami
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Correspondence to Frank H. Miller.

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Lopes Vendrami, C., Xu, X., McCarthy, R.J. et al. Body mass index as an indicator of the likelihood of ultrasound visualization of the appendix in pregnant women with suspicion of appendicitis. Abdom Radiol 45, 2637–2646 (2020). https://doi.org/10.1007/s00261-020-02610-7

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